Metrizamide

Metrizamide
Clinical data
Trade names	Amipaque
Other names	3-aAcetamido-2,4,6-triiodo-5-(N-methylacetamido)-N-[(3R,4R,5S,6R)-2,4,5-trihydroxy-6-(hydroxymethyl)oxan-3-yl]benzamide
AHFS/Drugs.com	Micromedex Detailed Consumer Information
ATC code	V08AB01 (WHO) ;
Identifiers
	IUPAC name 2-({3-(Acetylamino)-5-[acetyl(methyl)amino]-2,4,6-triiodobenzoyl}amino)-2-deoxy-D-glucopyranose;
CAS Number	31112-62-6 ;
PubChem CID	443944;
ChemSpider	391998 ;
UNII	RHH3W8F1CO;
ChEMBL	ChEMBL1200889 ;
CompTox Dashboard (EPA)	DTXSID1023310 ;
ECHA InfoCard	100.045.872
Chemical and physical data
Formula	C18H22I3N3O8
Molar mass	789.100 g·mol−1
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Metrizamide is a non-ionic iodine-based radiocontrast agent. A density gradient medium for the centrifugation of biological particles.

Historically metrizamide replaced iofendylate (trade names: Pantopaque, Myodil) as the contrast agent of choice for myelography (an X-ray study of the spine now largely replaced by MRI). The radio opacity characteristics are such that finer detail is displayed with metrizamide, as well as the advantage of reabsorption from spinal fluid and excretion from the body – since unlike Pantopaque, metrizamide is a water-soluble substance.

Both agents are administered by lumbar puncture (also referred to as a spinal tap or cisternal puncture), at the cervicocranial junction. The human patient is rolled from the lateral decubitus (lying on the side) to prone. Ankles are strapped to the end of a hard X-ray, CT, or MRI table. To obtain images of the cervical region the patient is then carefully tilted in the Trendelenberg position (head down) so the contrast agent (particularly Pantopaque) can enter the neck region. Care is given to prevent spilling dye into the posterior cranial fossa (back of the head) or to enter the cranial cavity in general. This speaks to the inability to remove the heavier or more viscous Pantopaque without aspirating it with spinal fluid (CSF) through a lumbar puncture needle in the low back (sticking up vertically) or back of the neck. Removal of Pantopauqe is necessary since it is non water-soluble. With metrizamide the issue is that if entering the cranial cavity and high dose exposure to the blood brain barrier, side effects are more likely encountered. Issues related to absorption into the general circulation are also encountered.

Side effects

Headache
Nausea
Vomiting
Mass effect, herniation, and major central nervous system complications including spinal cord compression
Seizures
Muscle rigidity and dystonic reaction

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References

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